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Tytuł:
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Assessment of Clinical Outcomes Among Children and Adolescents Hospitalized With COVID-19 in 6 Sub-Saharan African Countries.
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Autorzy:
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Nachega JB; Department of Epidemiology, Infectious Diseases and Microbiology, Center for Global Health, University of Pittsburgh, Pittsburgh, Pennsylvania.; Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa.; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Sam-Agudu NA; International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria.; Institute of Human Virology, University of Maryland School of Medicine, Baltimore.; Department of Pediatrics, University of Maryland School of Medicine, Baltimore.; Department of Pediatrics and Child Health, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana.
Machekano RN; Division of Epidemiology and Biostatics, Department of Global Health, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa.
Rabie H; Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa.
van der Zalm MM; Desmond Tutu TB Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa.
Redfern A; Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa.
Dramowski A; Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa.
O'Connell N; Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa.
Pipo MT; Department of Public Health, Centre Interdisciplinaire de Recherche en Ethnopharmacologie, Faculty of Medicine, Université Notre-Dame du Kasayi, Kananga, Democratic Republic of the Congo.; Unit of Sickle Cell Disease and Clinical Research, Monkole Hospital Center, Kinshasa, Democratic Republic of the Congo.
Tshilanda MB; Unit of Sickle Cell Disease and Clinical Research, Monkole Hospital Center, Kinshasa, Democratic Republic of the Congo.
Byamungu LN; Department of Pediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa.
Masekela R; Department of Pediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa.
Jeena PM; Department of Pediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa.
Pillay A; Department of Pediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa.
Gachuno OW; Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya.
Kinuthia J; Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya.
Ishoso DK; Community Health Department, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo.
Amoako E; Department of Pediatrics, Cape Coast Teaching Hospital, Cape Coast, Ghana.
Agyare E; Department of Microbiology, School of Medical Sciences, University of Cape Coast and Cape Coast Teaching Hospital, Cape Coast, Ghana.
Agbeno EK; Department of Obstetrics and Gynecology, School of Medical Sciences, University of Cape Coast and Cape Coast Teaching Hospital, Cape Coast, Ghana.
Martyn-Dickens C; Pediatrics Infectious Diseases Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
Sylverken J; Pediatrics Infectious Diseases Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana.; Department of Child Health, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Enimil A; Pediatrics Infectious Diseases Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana.; Department of Child Health, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Jibril AM; Department of Pediatrics, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria.
Abdullahi AM; Department of Internal Medicine, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria.
Amadi O; Department of Pediatrics, Asokoro District Hospital, Abuja, Nigeria.
Umar UM; Department of Internal Medicine, Asokoro District Hospital, Abuja, Nigeria.
Sigwadhi LN; Division of Epidemiology and Biostatics, Department of Global Health, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa.
Hermans MP; Department of Endocrinology and Nutrition, Cliniques Universitaires St-Luc, Brussels, Belgium.
Otokoye JO; Health Emergencies Program, COVID-19 Response, World Health Organization, Kinshasa, Democratic Republic of the Congo.
Mbala-Kingebeni P; National Institute of Biomedical Research, Department of Medical Microbiology and Virology, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo.
Muyembe-Tamfum JJ; National Institute of Biomedical Research, Department of Medical Microbiology and Virology, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo.
Zumla A; Division of Infection and Immunity, Centre for Clinical Microbiology, University College London, London, United Kingdom.; National Institute for Health Research Biomedical Research Centre, University College London Hospitals National Health Services Foundation Trust, London, United Kingdom.
Sewankambo NK; School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
Aanyu HT; Department of Pediatrics, Mulago Hospital, Kampala, Uganda.
Musoke P; Department of Pediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda.
Suleman F; Discipline of Pharmaceutical Sciences, University of KwaZulu Natal, Durban, South Africa.
Adejumo P; Department of Nursing, University of Ibadan, Ibadan, Nigeria.
Noormahomed EV; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
Deckelbaum RJ; Department of Pediatrics, Institute of Human Nutrition, Columbia University Irving Medical Center, New York, New York.
Fowler MG; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Tshilolo L; Department of Pediatrics, Official University of Mbuji-Mayi, Kinshasa, Democratic Republic of the Congo.; Le Centre de Formation et d'Appui Sanitaire, Centre Hospitalier Monkole, Kinshasa, Democratic Republic of the Congo.
Smith G; Department of Real World and Advanced Analytics, Cytel, Vancouver, British Columbia, Canada.
Mills EJ; Department of Real World and Advanced Analytics, Cytel, Vancouver, British Columbia, Canada.; Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Umar LW; Department of Pediatrics, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria.
Siedner MJ; Department of Medicine, Division of Infectious Diseases, Harvard Medical School, Massachusetts General Hospital, Boston.; Department of Medicine, School of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
Kruger M; Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa.
Rosenthal PJ; Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, San Francisco.
Mellors JW; Department of Medicine, Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Mofenson LM; Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia.
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Corporate Authors:
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African Forum for Research and Education in Health (AFREhealth) COVID-19 Research Collaboration on Children and Adolescents
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Źródło:
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JAMA pediatrics [JAMA Pediatr] 2022 Mar 01; Vol. 176 (3), pp. e216436. Date of Electronic Publication: 2022 Mar 07.
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Typ publikacji:
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Journal Article
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Język:
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English
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Imprint Name(s):
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Original Publication: Chicago, IL : American Medical Association, [2013]-
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MeSH Terms:
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Child, Hospitalized*
Outcome Assessment, Health Care*
COVID-19/*therapy
Pneumonia, Viral/*therapy
Adolescent ; Africa South of the Sahara/epidemiology ; COVID-19/epidemiology ; COVID-19/mortality ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Length of Stay/statistics & numerical data ; Male ; Oxygen Inhalation Therapy ; Pandemics ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/mortality ; Pneumonia, Viral/virology ; Respiration, Artificial ; SARS-CoV-2
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References:
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Grant Information:
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001 International WHO_ World Health Organization; D43 TW010135 United States TW FIC NIH HHS; K43 TW011028 United States TW FIC NIH HHS; R25 TW011217 United States TW FIC NIH HHS
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Contributed Indexing:
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Investigator: JB Nachega; NA Sam-Agudu; RN Machekano; H Rabie; MM Van der Zalm; A Redfern; A Dramowski; N O'Connell; MT Pipo; MB Tshilanda; LN Byamungu; R Masekela; PM Jeena; A Pillay; OW Gachuno; J Kinuthia; DK Ishoso; E Amoako; E Agyare; EK Agbeno; C Martyn-Dickens; J Sylverken; A Enimil; AM Jibril; AM Abdullahi; O Amadi; UM Umar; LN Sigwadhi; MP Hermans; JO Otokoye; P Mbala-Kingebeni; A Zumla; HT Aanyu; P Musoke; F Suleman; EV Noormahomed; MG Fowler; L Tshilolo; M Kruger; G Smith; PJ Rosenthal; EJ Mills; LW Umar; JW Mellors; P Adejumo; NK Sewankambo; MJ Siedner; RJ Deckelbaum; JJ Muyembe-Tamfum; LM Mofenson; N Mongweli; PS Nyasulu; J Madinga; CB Nswe; JN Kayembe; A Mukalay; A Mteta; A Tsegaye; DJM Landu; S Zigabe; A Goga; R Ehrlich; AP Kengne; JL Johnson; P Kilmarx; B Ayele; IN Dasoberi; C Sam-Woode; G Yeboah; C Adirieje
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Entry Date(s):
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Date Created: 20220119 Date Completed: 20220310 Latest Revision: 20221231
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Update Code:
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20240105
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PubMed Central ID:
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PMC8771438
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DOI:
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10.1001/jamapediatrics.2021.6436
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PMID:
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35044430
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Importance: Little is known about COVID-19 outcomes among children and adolescents in sub-Saharan Africa, where preexisting comorbidities are prevalent.
Objective: To assess the clinical outcomes and factors associated with outcomes among children and adolescents hospitalized with COVID-19 in 6 countries in sub-Saharan Africa.
Design, Setting, and Participants: This cohort study was a retrospective record review of data from 25 hospitals in the Democratic Republic of the Congo, Ghana, Kenya, Nigeria, South Africa, and Uganda from March 1 to December 31, 2020, and included 469 hospitalized patients aged 0 to 19 years with SARS-CoV-2 infection.
Exposures: Age, sex, preexisting comorbidities, and region of residence.
Main Outcomes and Measures: An ordinal primary outcome scale was used comprising 5 categories: (1) hospitalization without oxygen supplementation, (2) hospitalization with oxygen supplementation, (3) ICU admission, (4) invasive mechanical ventilation, and (5) death. The secondary outcome was length of hospital stay.
Results: Among 469 hospitalized children and adolescents, the median age was 5.9 years (IQR, 1.6-11.1 years); 245 patients (52.4%) were male, and 115 (24.5%) had comorbidities. A total of 39 patients (8.3%) were from central Africa, 172 (36.7%) from eastern Africa, 208 (44.3%) from southern Africa, and 50 (10.7%) from western Africa. Eighteen patients had suspected (n = 6) or confirmed (n = 12) multisystem inflammatory syndrome in children. Thirty-nine patients (8.3%) died, including 22 of 69 patients (31.9%) who required intensive care unit admission and 4 of 18 patients (22.2%) with suspected or confirmed multisystem inflammatory syndrome in children. Among 468 patients, 418 (89.3%) were discharged, and 16 (3.4%) remained hospitalized. The likelihood of outcomes with higher vs lower severity among children younger than 1 year expressed as adjusted odds ratio (aOR) was 4.89 (95% CI, 1.44-16.61) times higher than that of adolescents aged 15 to 19 years. The presence of hypertension (aOR, 5.91; 95% CI, 1.89-18.50), chronic lung disease (aOR, 2.97; 95% CI, 1.65-5.37), or a hematological disorder (aOR, 3.10; 95% CI, 1.04-9.24) was associated with severe outcomes. Age younger than 1 year (adjusted subdistribution hazard ratio [asHR], 0.48; 95% CI, 0.27-0.87), the presence of 1 comorbidity (asHR, 0.54; 95% CI, 0.40-0.72), and the presence of 2 or more comorbidities (asHR, 0.26; 95% CI, 0.18-0.38) were associated with reduced rates of hospital discharge.
Conclusions and Relevance: In this cohort study of children and adolescents hospitalized with COVID-19 in sub-Saharan Africa, high rates of morbidity and mortality were observed among infants and patients with noncommunicable disease comorbidities, suggesting that COVID-19 vaccination and therapeutic interventions are needed for young populations in this region.
Comment in: JAMA Pediatr. 2022 Mar 1;176(3):e216446. (PMID: 35044429)
Comment in: JAMA Pediatr. 2022 Jul 1;176(7):727-728. (PMID: 35532906)
Comment in: JAMA Pediatr. 2022 Jul 1;176(7):728. (PMID: 35532909)
